Otolaryngology Coding Alert

Question: Our physician wants to bill 38500 for a deep lymph node excision of the cheek. I read that all facial lymph node excisions are superficial, but this one goes down to muscle. I did question him about using code 21013, but the pathology report came back as a really high level 2 lymph node with granulomatous lymphadentitis. Any thoughts?

Washington Subscriber

Answer: Nearly all of the lymph nodes in the head, face, and neck are part of the cervical system. Some are near the surface of the skin, usually under the chin and on the back of the neck; many more are deep within the muscular structure.

From the Coding Desk Reference for CPT^®code 38500 (Biopsy or excision of lymph node[s]; open, superficial): “The physician performs a biopsy on or removes one or more superficial lymph nodes. The physician makes a small incision through the skin overlying the lymph node. The tissue is dissected to the node. A small piece of the node and surrounding tissue is removed, or the node may be removed. The incision is repaired with a layered closure.”

Other related coding options include:

• 38505 — …by needle, superficial (e.g., cervical, inguinal, axillary)
• 38510 — … open, deep cervical node(s)
• 38520 — …open, deep cervical node(s) with excision scalene fat pad.

There is a good chance that this lymph node excision would fall under 68510 (Biopsy of lacrimal gland) or 38520, but it cannot be determined without the operative note.